X (A Child), Re (Rev 1)

In deciding whether life-sustaining treatment should be withdrawn from a child, the child’s welfare and best interests are paramount. There is a strong presumption in favour of preserving life, but it is rebuttable. The court must balance the medical, emotional and wider welfare benefits of continued treatment against its burdens and disadvantages. Where death is inevitable, continued artificial support may cease to be in the child’s best interests if it offers no realistic prospect of recovery and prolongs pain, deterioration or an undignified decline. In an urgent case, proportionality may justify refusing an adjournment where further records are unlikely significantly to affect the decision.

An NHS Trust applied under the inherent jurisdiction for a declaration that it would be lawful to withdraw mechanical cardiac and respiratory support from X, an 11-year-old child. X’s parents opposed the application, while the Children’s Guardian supported it.

X had suffered catastrophic heart and lung failure. The medical evidence was unanimous that he was no longer a candidate for transplantation, that no effective surgical option remained, and that continued support would inevitably lead to death after further deterioration. The father sought an adjournment to allow counsel to examine approximately 7,500 pages of medical records. The central issues were whether the declaration should be granted and whether the hearing should be adjourned.

1. The declaration was granted. The court accepted the unanimous medical evidence that no intervention could save X’s life and that death was inevitable. Continued mechanical support would result in a prolonged decline, with risks including bleeding, infection and progressive organ failure.

2. The child’s welfare and best interests were paramount. Applying the approach in Wyatt v Portsmouth NHS Trust [2006] 1 FLR 554, the court treated preservation of life as a strong but rebuttable starting point. The relevant assessment required a balance of the benefits and burdens of continued treatment, viewed from the child’s assumed perspective and including medical, emotional and other welfare considerations.

3. There were benefits in continued life support, including X’s continued life and the society, love and support of his family. Those benefits were outweighed by the much stronger burdens. Treatment offered no realistic prospect of recovery or transplantation and would prolong pain, physical deterioration and an unpredictable decline.

4. The application for an adjournment was refused. In a case of extreme urgency, proportionality required the court to weigh the need for further investigation against the child’s immediate interests. It was extremely unlikely that examination of the recently disclosed medical records would materially inform the decision, and delay offered no realistic prospect of a different outcome.

5. The court concluded that withdrawal of life support would provide X with the best prospect of an orderly and dignified death surrounded by his family. The NHS Trust had established its case.

• High Court (Family Division): Declaration granted permitting withdrawal of life-sustaining treatment.
• Court of Appeal: On 7 October 2015, the parents’ application for permission to appeal was dismissed. No citation is stated in the judgment.